Lethal consequences.
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Antibiotic Prophylaxis↗
Biomedical subjects
B Fabri
Publications and source records attributed to B Fabri.
Validation of four different risk stratification systems in patients undergoing off-pump coronary artery bypass surgery: a UK multicentre analysis of 2223 patients.
BACKGROUND: Various risk stratification systems have been developed in coronary artery bypass graft surgery (CABG), based mainly on patients undergoing procedures with cardiopulmonary bypass. OBJECTIVE: To assess the validity and applicability of the Parsonnet score, the EuroSCORE, the American College of Cardiology/American Heart Association (ACC/AHA) system, and the UK CABG Bayes model in patients undergoing off-pump coronary artery bypass surgery (OPCAB) in the UK. METHODS: Data on 2223 patients who underwent OPCAB in eight cardiac surgical centres were collected. Predicted mortality risk scores were calculated using the four systems and compared with observed mortality. Calibration was assessed by the Hosmer-Lemeshow (HL) test. Discrimination was assessed using the receiver operating characteristic (ROC) curve area. RESULTS: 30 of 2223 patients (1.3%) died in hospital. For the Parsonnet score the HL test was significant (p < 0.001) and the receiver operating characteristic curve (ROC) area was 0.74. For the EuroSCORE the HL test was also significant (p = 0.008) and the ROC area was 0.75. For the ACC/AHA system the HL test was non-significant (p = 0.7) and the ROC area was 0.75. For the UK CABG Bayes model the HL test was also non-significant (p = 0.3) and the ROC area was 0.81. CONCLUSIONS: The UK CABG Bayes model is reasonably well calibrated and provides good discrimination when applied to OPCAB patients in the UK. Among the other three systems, the ACC/AHA system is well calibrated but its discrimination power was less than for the UK CABG Bayes model. These data suggest that the UK CABG Bayes model could be an appropriate risk stratification system to use for patients undergoing OPCAB in the UK.
Coronary Artery Bypass↗
Myocardial ischaemia after coronary artery bypass grafting: early vs late extubation.
The technique of early extubation after coronary artery bypass grafting is increasing in popularity, but its safety and effect on myocardial ischaemia remain to be established. In a randomized, prospective study, patients undergoing routine elective coronary artery bypass grafting were managed with either early or late tracheal extubation. The incidence and severity of electrocardiographic myocardial ischaemia were compared. Data were analysed from 85 patients (43 early extubation; 42 late extubation). Median time to extubation was 110 min in the early extubation patients and 757 min in the late extubation patients. After correction for randomization bias, there were no significant differences between groups in ischaemic burden, maximal ST-segment deviation, incidence of ischaemia and area under the ST deviation-time curve (integral of ST deviation and time). Similarly, there were no differences between groups in postoperative creatine kinase MB-isoenzyme concentrations and duration of stay in the ICU or hospital. Therefore, this study provides evidence for the safety of early extubation after routine coronary artery bypass grafting.
Adult↗
Trisomy 16 fetus surviving into the second trimester.
A 27-year-old gravida 4, para 3 was found to have anhydramnios at 14 weeks' gestation following a size/date discrepancy noted at her routine prenatal visit. A detailed ultrasound revealed multiple fetal anomalies including congenital heart defect, chest hypoplasia, and bilateral dysplastic kidneys. Karyotype revealed trisomy 16 in 15/15 cells from a tissue specimen obtained from the fetal cord insertion site following elective pregnancy termination.
Abnormalities, Multiple↗
Selective decontamination of the gut.
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Critical Care↗
Pericardial constriction caused by primary mesothelioma.
Primary pericardial mesothelioma is an extremely rare tumour. This case illustrates the typical late presentation with symptoms and signs of constrictive pericarditis. An unusual feature was complete encasement of the heart by tumour. No satisfactory treatment is available.
Aged↗
Subcutaneous technique for saphenous vein harvest.
A subcutaneous technique of saphenous vein harvesting is described, and the results of its use in 37 consecutive patients requiring two or more grafts are presented. The technique minimizes the handling of the vein and reduces leg wound complications and patient discomfort.
Coronary Artery Bypass↗
Cervical thymectomy in the treatment of myasthenia gravis.
A retrospective review of 22 patients undergoing cervical thymectomy for myasthenia gravis is presented. Their ages ranged from 19 to 67 years. The male and female ratio as well as the severity of illness prior to operation were similar to other reported series. All patients were evaluated from the standpoint of clinical response to thymectomy, and the number and dosage of anti-myasthenic drugs required after operation. There was a statistically significant improvement in clinical status in the immediate postoperative period (P less than 0.05) and a further significant improvement was noted at six months (P less than 0.05). In addition, significant reductions in postoperative drug therapy were noted (P less than 0.05). Complications from cervical thymectomy were minimal and mortality was zero. An attempt was made to correlate histological findings with clinical results. Comparison is made to other series in the literature and the advantages of the cervical technique as the initial surgical approach are described. The data presented support a useful role for cervical thymectomy in the treatment of myasthenia gravis.
Adult↗
Oesophagogastrectomy using the end-to-end anastomosing stapler.
The use of a mechanical instrument for accomplishing end-to-side oesophagogastrostomy is described. We report our experience with 30 consecutive patients undergoing oesophagogastrectomy--26 for malignant disease and four for benign peptic stricture. There were two immediate postoperative deaths. One patient developed a chylothorax and died six weeks after operation. The instrument failed to function satisfactorily on one occasion. There were no anastomotic leaks.
Adenocarcinoma↗